Posology : מינונים

4.2 Posology and method of administration

Glucomin can be halved. There is no information regarding crushing or chewing of the caplets. The caplets are coated to avoid the bitter taste of the medicine.

In case of need, the medicine can be divided to halves (425 mg). A dose of 425 mg can be an alternative to a 500 mg dose.

Posology
Adults with normal renal function (GFR≥ 90 mL/min)
Monotherapy and combination with other oral antidiabetic agents
The usual starting dose is 500 mg or 850 mg metformin hydrochloride 2 or 3 times daily given during or after meals.
After 10 to 15 days the dose should be adjusted on the basis of blood glucose measurements. A slow increase of dose may improve gastrointestinal tolerability.
The maximum recommended dose of metformin hydrochloride is 2550 mg daily, taken as 3 divided doses.
If transfer from another oral antidiabetic agent is intended: discontinue the other agent and initiate metformin at the dose indicated above.
Combination with insulin
Metformin and insulin may be used in combination therapy to achieve better blood glucose control. Metformin hydrochloride is given at the usual starting dose of 500 mg or 850 mg 2 or 3 times daily, while insulin dosage is adjusted on the basis of blood glucose measurements.
Elderly
Due to the potential for decreased renal function in elderly subjects, the metformin dosage should be adjusted based on renal function. Regular assessment of renal function is necessary (see section 4.4).
Renal impairment
A GFR should be assessed before initiation of treatment with metformin containing products and at least annually thereafter. In patients at an increased risk of further progression of renal impairment and in the elderly, renal function should be assessed more frequently, e.g. every 3-6 months.
GFR                Total maximum daily dose                          Additional considerations (mL/min)           (to be divided into 2-3 daily doses)

60-89              2550 mg                                           Dose reduction may be considered in relation to declining renal function.

45-59              2000 mg                                           Factors that may increase the risk of lactic acidosis
(see section 4.4) should be reviewed before considering initiation of metformin.
The starting dose is at most half of the maximum
30-44              1000 mg                                           dose.

<30                -                                                 Metformin is contraindicated.


Paediatric population
Monotherapy and combination with insulin
• Glucomin can be used in children from 10 years of age and adolescents.
• The usual starting dose is 500 mg or 850 mg metformin hydrochloride once daily, given during or after meals.
After 10 to 15 days the dose should be adjusted on the basis of blood glucose measurements.
A slow increase of dose may improve gastrointestinal tolerability. The maximum recommended dose of metformin hydrochloride is 2 g daily, taken as 2 or 3 divided doses.